Association of hospital-level continuous kidney replacement therapy use and mortality in critically ill patients with acute kidney injury.
Critically ill patients with acute kidney injury who needed dialysis were less likely to die when treated at hospitals that use continuous kidney replacement therapy more often, suggesting institutional experience and capacity matter.
Background
In many high-risk conditions, higher procedural volume is associated with better outcomes. This study tested whether hospital-level CKRT utilization is associated with mortality in critically ill AKI patients.
Key findings
Across 49,685 patients with AKI treated with kidney replacement therapy in 426 U.S. hospitals offering both CKRT and intermittent hemodialysis, higher hospital-level CKRT utilization was associated with lower patient-level risk-adjusted mortality. Hospitals in the highest utilization quartile had a 15% lower adjusted probability of death versus the lowest quartile (fourth vs first quartile adjusted hazard ratio 0.85, 95% CI 0.81-0.89).
Clinical implications
The findings suggest that institutional CKRT capability and experience, not just modality selection for an individual patient, may influence survival - relevant to ICU staffing, equipment, and referral or regionalization decisions.
Category
Research
Source
Intensive Care Medicine
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